2010.12.04 18:44
Medicare Open Enrollment: Nov. 15 - Dec. 31 Medicare Plans in 2011: What You Need to KnowNow is the time to review your coverage options for the coming year by: Patricia Barry | from: AARP Bulletin | November 15, 2010 Once again it's time for people with Medicare to review their drug and health plans and, if they want to, switch to another plan with better benefits or lower costs. In the past, relatively few people took this opportunity. But major changes for 2011 — some the result of the new health care law — make it important to pay attention to what's in store for next year. Changes At a GlanceCosts: If you fall into the Part D "doughnut hole," you'll get a 50 percent discount on brand-name prescription drugs. Premiums: If you pay higher-income premiums for Part B, you'll also pay a higher premium for Part D drug coverage. Choice: Some current plans will no longer be available, but you'll still have plenty to choose from — between 28 and 38 prescription drug plans in each state, and at least 10 Medicare Advantage plan options in all but 29 counties. Free services: Traditional Medicare and most Medicare Advantage health plans will charge nothing for an annual physical and many preventive services such as mammograms and prostate cancer screenings. Capped costs: Annual out-of-pocket medical expenses (excluding premiums and prescription drug costs) in most MA health plans will be capped at a maximum $6,700 for 2011. Some plans have much lower limits. Being a savvy consumer means reviewing your current plan's costs and benefits for next year, which are all itemized in the "Annual Notice of Change" letter that the plan has sent you; comparing your plan with others available; and then, if you choose to switch, signing up with a different plan during open enrollment, which began Nov. 15 and ends Dec. 31. Here's a checklist for assessing changes in 2011, for those enrolled in a "stand-alone" drug plan — your plan if you receive your medical benefits through the traditional Medicare program — and for those in a Medicare Advantage plan, which provides medical benefits and drug coverage in one package. Will my plan still be there next year? Among the plans that won't be offered in 2011 are two of the largest: the AARP MedicareRx Saver plan, with more than 1.5 million enrollees, and the PrescribaRx Bronze, with more than 480,000. If you're enrolled in any plan that is unavailable next year, you'll automatically be switched to another offered by the same insurer, or you can choose a different plan during open enrollment.
Health plans: Many people enrolled in the Medicare Advantage program — a collection of mainly HMO and PPO managed care plans — fear their plans will disappear because the new health care law will gradually reduce the government subsidies these plans have received for the past seven years. But that process doesn't begin until 2012. However, some non-managed-care plans known as private fee-for-service (PFFS) have chosen to pull out of the program because of a different 2008 law that takes effect in January. For the first time, most of these plans will be required to establish contracts with doctors, hospitals and other providers — something HMOs and PPOs have always had to do — so that enrollees can be sure which providers will accept their plan. As a result, the number of PFFS plans nationwide will drop from 435 to 239 in 2011. If you're in a health plan that's withdrawing, you'll need to choose another or return to traditional Medicare. There will be a choice of plans in almost every locality — scores of them in some large cities. But in a few rural areas — 28 counties in Colorado and one in Utah — no Medicare Advantage plans will be available in 2011. In those areas, you'll receive your medical benefits from traditional Medicare next year and must enroll in a drug plan to get prescription coverage. Major changes for 2011 make it important to pay attention to what's in store for next year. Will my premiums go up? On average, premiums for stand-alone drug plans will rise by $1 a month, according to Medicare officials. But a more detailed analysis from Avalere Health, a consulting company that tracks Part D trends, finds some people will see their current premiums drop next year while others will see big increases. The lowest premium will be $14.80 a month for a new basic plan offered by Humana in all states. The lowest premiums for "enhanced" plans that offer some coverage in the doughnut hole will range from $32.90 in Arizona to $52 in Alaska. One big change coming next year is a direct result of the new health care law: People who pay higher Part B premiums because of high incomes also will begin paying higher premiums for Part D. In both cases, the higher rates affect people with taxable incomes above $85,000 a year, or $170,000 for married couples filing joint tax returns. Medicare officials say that the higher Part D premium surcharges will range from $12 to $69.10 a month, according to income level, regardless of whether a person has drug coverage through a stand-alone plan or a Medicare Advantage plan, in addition to the premium that plan normally charges. Will I see higher copays? Most plans change their copayments every year, and 2011 is no exception. That's why it's always important to shop around, especially for drug coverage options. But this year there's good news on out-of-pocket expenses, all the result of the new law:
Will I have fewer benefits? Medical benefits available through traditional Medicare will be covered in all Medicare Advantage plans, as they've always been. But what of those "extras" that attract many people to the plans — like routine dental, vision and hearing care, health club memberships and fitness classes?
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We, as physicians, are in the position to tell our patients how to deal with Medicare.
But, so many times, we know much less than what we should.
We file claims to Medicare or other insurance companies
but we hardly know what they do to our patients.
When I got covered by Medicare, I hardly knew what it was about.
To be a good doctor and also for our own good, we need to learn how Medicare covers us.
I don't know what are to happen in our taxes, Medicare, and social security benefits
after the ongoing year-end squabble between Democrats and Republicans,
but we will be much better off to study ahead of time. The above article will help us.